2017 Diseases of Inner Ear Hearing Loss Tinnitus

DISEASES&OF&THE&INNER&
EAR
HEARING(LOSS
KMDT
• Cochlear(or(sensory(hearing(loss
• Sensorineural(hearing(loss(– cochlea
• Neural/Retrocochlear hearing(loss
• Auditory(nerve(lesion((eg.(Acoustic(neuroma)
• Central(hearing(loss
• Lesion(of(the(central(auditory(pathway
Symptoms&of&inner&ear&disorders
• Hearing(impairment
• Decreased(hearing(threshold(or(hypoacusis
• Distortion(of(hearing(or(dysacusis
• Tinnitus
• Vestibular(symptoms
• Dysequilibrium
• Vertigo
Diagnostic&Evaluation
• History
• Noise(exposure,(cranial(trauma,(family(hx,(hx of(COM,(
ototoxic(drug(use
• Clinical(Examination
• PE,(otoscopy,(TFTs((Weber,(Rinne),(whispered(speech(test
• Audiometric(Studies
• Pure(tone(audiometry
• ABR/ASSR
• Imaging(studies
• CT(scan
• MRI
COCHLEAR&HEARING&LOSS&WITH&A&
KNOWN&CAUSE
1. Hereditary(sensorineural(HL
2. NoiseUinduced(HL
3. Traumatic(injury(to(the(inner(ear
4. Labyrinthitis
5. Ototoxicity
6. Other(acquired(inner(ear(disorders
1. Immunologic(causes
2. Decreased(blood(flow
3. Metabolic(disorders
4. Cochlear(otosclerosis
HEREDITARY&SENSORINEURAL&HL
• Syndromic – present(at(birth(and(autosomal(
recessive
• NonUsyndromic –
• Congenital(form
• Later(onset
• Autosomal(dominant
• Symmetrical(
HEREDITARY&SENSORINEURAL&
HL:TREATMENT
• Prevention(of(further(acquired(damage
• Rehabilitation(with(hearing(aids(and(other(hearing(
assistive(devices
• Gene(pool(counselling(
NOISEHINDUCED&HL
• Acute(acoustic(trauma
• Blast(injury
• Acute(noiseUinduced(HL
• Chronic(noiseUinduced(HL
NOISEHINDUCED&HL:&SYMPTOMS
1. Muffled(sensation(and(tinnitus
2. Transient(NIHL(or(irreversible(NIHL
• BOTH(are(sensorineural(HL(with(loss(of(speech(
discrimination
NOISEHINDUCED&HL:&PROPHYLAXIS
1. Reduction(of(noise(emissions(– use(of(hearing(
protection(and(control(of(noise(levels
2. Regular(screening(of(workers(and(the(work(place
3. Educational(hearing(conservation(programs
TRAUMATIC&INJURY&TO&THE&INNER&
EAR
• Labyrinthine(concussion/contusion
• Labyrinthine(trauma
• Cochlear(trauma
EAR:&CAUSES
• Temporal(bone(fractures
• Barotrauma
• Blast(injuries
EAR:&TREATMENT
• Protection(from(other(harmful(influences
• Correction(of(hearing(loss
• Rehabilitation(
LABYRINTHITIS:&CAUSES
• Tympanogenic
• Meningeal
• Hematogenous
LABYRINTHITIS:&SYMPTOMS
• Cochlear(HL
• Tinnitus
• Vertigo
• Dysequilibrium
• nystagmus
LABYRINTHITIS:&TREATMENT
1. Decompression(with(myringotomy or(ventilation(
tube
2. Mastoidectomy – to(eradicate(an(infection
OTOTOXICITY:&SYMPTOMS
• Cochlear(damage((hearing(loss)
• Always(sensorineural
• DoseUrelated
• May(be(permanent(if(with(prolonged(exposure
• Usually(symmetrical
• Oscillopsia
• dysequilibrium
OTOTOXIC&SUBSTANCE:
1. DRUGS
1. Aminoglycosides
2. Loop(diuretics((furosemide)
3. Quinine
4. Salicylates
5. Cisplatin
2. Industrial(Toxins
1. Aminobenzenes
2. Heavy(metals(eg.(Pb,(Hg
3. Arsenic
4. Alcohol,(tobacco,(cocaine,(heroin
OTOTOXICITY:&PROPHYLAXIS
1. Screening(and(monitoring(of(cochlear(function
2. Must(give(special(attention(to(drug(dosage,(renal(
function(and(hydration
DISEASES&OF&THE&INNER&
EAR
TINNITUS
TINNITUS
• Noise(or(ringing(in(the(ear
• Usually(SUBJECTIVE(but(occasionally(OBJECTIVE
• Often(a(sign(of(disease(of(the(ear
• Severely(affects(the(quality(of(life
SUBJECTIVE&TINNITUS
• May(arise(from(problems(in(the(external(ear,(
tympanic(membrane,(ossicles,(cochlea,(eighth(
cranial
• Tinnitus(audible(only(to(the(patient(nerve,(
brainstem,(or(cortex
CAUSES&OF&SUBJECTIVE&TINNITUS
• Arteriosclerosis
• Hypertension
• Tumors
• Menier’s disease
• Anemia
• Low(BP(
• Syphilis(of(the(CNS
CAUSES&OF&SUBJECTIVE&TINNITUS
• Epilepsy
• Migraine
• Neurogenic/functional(in(origin
• Auditory(hallucination
DRUGS&PRODUCING&TINNITUS
• AntiUcancer(drugs
• Antibiotic/Antiparasitic
• Diuretics
• Antipyretics(
• AntiUdepressants
• Oral(contraceptives
• Narcotic(analgesics
OBJECTIVE&TINNITUS:
• Patient’s(tinnitus(heard(by(the(examiner
• Character(of(the(tinnitus:
• Blowing
• Pulsating
• clicking
CAUSES&OF&OBJECTIVE&TINNITUS:
• Abnormally(patent(Eustachian(Tube
• Patulous(Eustachian(Tube
• Palatal(myoclonus
• Arteriovenous(aneurysm
Treatment&options&for&TINNITUS:
1. Tinnitus(Retraining(Therapy((TRT)(
• Educational(counselling(and(sound(therapy
2. Tinnitus(Treatment(Solutions((TTS)
• Habituation(+(devices((purchased)
3. Neuromonics
• Counselling(+(devices
4. Soundcure
5. Otoharmonics
6. Progressive(Tinnitus(Management((PTM)
• If(there(is(hearing(loss(+(tinnitus,(hearing(aids(will(
be(recommended
• Sometimes,(prescribing(an(appropriate(hearing(aid(
alone(can(help(alleviate(the(tinnitus(
• There(is(still(no(cure(for(tinnitus
• But(there(are(treatments(that(can(help
• Ergo,(never(dismiss(your(patient(saying(“learn(to(
live(with(it”
HEARING&LOSS&and&TINNITUS
• All(causes(of(hearing(loss(cause(tinnitus(to(a(certain(
extent
• Correction(of(the(hearing(loss(is(attempted(first(
before(treating(the(tinnitus
KMDT

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DISEASES&OF&THE&INNER&

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